Wang Che-Chuan, Chang Chin-Hung, Lin Hung-Jung, Lin Kao-Chang, Kuo Jinn-Rung
Department of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan.
Eur Spine J. 2009 Jul;18 Suppl 2(Suppl 2):210-2. doi: 10.1007/s00586-008-0819-2. Epub 2008 Nov 13.
Spontaneous spinal epidural haemorrhage is a rare condition. The initial clinical manifestations are variable. Nonetheless, most spinal cord lesions result in paraparesis or quadriparesis, but not hemi-paresis, if motor function is involved. We report on a 69-year-old man who presented initially with right-side limb weakness. He was initially misdiagnosed at emergency room with a cerebral stroke and treated inappropriately with heparin. One day after admission, correct diagnosis of acute spinal epidural haematoma was based on the repeated neurological examination and cervical magnetic resonance imaging study. The patient underwent emergency surgical decompression and hematoma removal. The pathogenesis of the haematoma could have been due to hypertension, increased abdominal pressure and anticoagulant therapy. We emphasize that patients with hemi-paresis on initial presentation could have an acute spinal epidural haemorrhage. We also draw the misdiagnosis to the attention of the reader because early recognition of spontaneous spinal epidural haematoma is very important for prompt and appropriate treatment to improve the overall prognosis.
自发性脊髓硬膜外出血是一种罕见病症。其初始临床表现多样。尽管如此，如果运动功能受累，大多数脊髓损伤会导致截瘫或四肢瘫，而非偏瘫。我们报告一例69岁男性，最初表现为右侧肢体无力。他最初在急诊室被误诊为脑卒中，并接受了不恰当的肝素治疗。入院一天后，基于反复的神经学检查和颈椎磁共振成像研究，正确诊断为急性脊髓硬膜外血肿。血肿的发病机制可能是由于高血压、腹压增加和抗凝治疗。我们强调，初始表现为偏瘫的患者可能患有急性脊髓硬膜外出血。我们还提请读者注意误诊情况，因为早期识别自发性脊髓硬膜外血肿对于及时、恰当的治疗以改善总体预后非常重要。
